妊娠期糖尿病患者母血及脐血中subfatin和spexin水平的变化及其临床意义

Changes of subfatin and spexin levels in maternal and umbilical blood of gestational diabetes mellitus

目的探讨妊娠期糖尿病患者母血、脐血中subfatin和spexin水平的变化及其临床意义。方法前瞻性选取2019年1月至2020年3月同济大学附属第一妇婴保健院门诊建卡以及住院分娩的妊娠期糖尿病的妇女75例,及其所分娩的新生儿75例,为妊娠期糖尿病组;同时在选取糖耐量正常妊娠期妇女及其所分娩的新生儿各80例为对照组。测定两组产妇的葡萄糖、胰岛素、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸水平,采用酶联免疫吸附试验(ELISA)试剂盒测定母血、脐血中的subfatin和spexin水平,受试者工作特征(ROC)曲线分析母血、脐血中subfatin和spexin在妊娠期糖尿病中诊断的价值。结果妊娠期糖尿病组患者的母血、脐血葡萄糖、胰岛素、HOMA-IR、TC和TG水平为(5.86±0.42) mmol/L、(5.76±0.63)μU/mL、2.47±1.21、(5.37±1.19) mmol/L、(1.29±0.43) mmol/L,均显著高于对照组[(5.37±0.33) mmol/L、(3.97±0.45)μU/mL、1.16±0.78、(4.96±0.919) mmol/L、(0.86±0.29) mmol/L],差异均有统计学意义(P <0.05),妊娠期糖尿病组中LDL-C、HDL-C、尿酸水平与对照组相比,差异无统计学意义(P> 0.05);妊娠期糖尿病组中口服糖耐量试验前、分娩结束时母血、脐血subfatin水平为(14.27±4.52)、(7.54±1.17)、(8.59±2.23) ng/mL,均明显高于对照组[(4.13±0.93)、(3.26±0.78)、(6.29±1.27) ng/mL],差异均有统计学意义(P <0.05);妊娠期糖尿病组患者口服糖耐量试验前、分娩结束时母血、脐血spexin水平为(2.55±0.48)、(1.94±0.39)、(1.87±0.25) ng/mL,均显著低于对照组[(3.92±0.99)、(3.17±0.82)、(2.94±0.73) ng/mL],差异均有统计学意义(P <0.05)。ROC曲线分析结果显示,母血subfatin和spexin、脐血中subfatin和spexin诊断妊娠期糖尿病的曲线下面积为0.924(95%CI:0.875~0.934,P <0.001)、0.901(95%CI:0.849~0.9515,P <0.001)、0.858(95%CI:0.796~0.920,P <0.001)和0.799(95%CI:0.724~0.873,P <0.001),灵敏度为86.49%、81.57%、78.38%和75.68%,特异度为72.75%、75.68%、84.59%和89.24%。结论妊娠期糖尿病患者母血、脐血中subfatin水平升高,spexin降低,可以作为诊断妊娠期糖尿病的分子标志物。

Objective To investigate the changes of subfatin and spexin levels in maternal and umbilical blood of gestational diabetes mellitus patients and its clinical significance. Methods Seventy-five women with gestational diabetes mellitus and 75 newborns delivered from January 2019 to March 2020 in the Department of Outpatient of the First Maternity and Infant Health Hospital Affiliated to Tongji University were prospectively selected as gestational diabetes mellitus group. At the same time,80 pregnant women with normal glucose tolerance and 80 newborns were selected as the control group. The levels of glucose,insulin,Homeostasis model assessment for insulin resistance( HOMA-IR),total cholesterol( TC),triglyceride( TG),high density lipoprotein cholesterol( HDL-C),low density lipoprotein cholesterol( LDL-C) and uric acid were measured. The levels of subfatin and spexin in maternal blood and umbilical cord blood were measured by enzyme-linked immunosorbent assay( ELISA),receiver operating characteristic( ROC) curve was used to analyze the value of subfatin and spexin in maternal blood and cord blood in the diagnosis of gestational diabetes mellitus. Results The levels of glucose,insulin,HOMA-IR,TC and TG in maternal and umbilical blood of gestational diabetes group were( 5. 86 ± 0. 42) mmol/L,( 5. 76 ± 0. 63) μU/mL,2. 47 ± 1. 21,( 5. 37 ± 1. 19) mmol/L,( 1. 29 ± 0. 43)mmol/L,which were significantly higher than those in control group[( 5. 37 ± 0. 33) mmol/L,( 3. 97 ± 0. 45) μU/mL,1. 16 ± 0. 78,( 4. 96 ±0. 919) mmol/L,( 0. 86 ± 0. 29) mmol/L],the differences were statistically significant( P < 0. 05). The levels of LDL-C,HDL-C and uric acid in the gestational diabetes group were not significantly different from those in the control group( P > 0. 05). The levels of subfatin in maternal and umbilical blood before and after the oral glucose tolerance test in the gestational diabetes group were( 14. 27 ± 4. 52),( 7. 54 ± 1. 17),( 8. 59 ± 2. 23) ng/mL,which were significantly higher than those in the control group [( 4. 13 ±0. 93),( 3. 26 ±0. 78),( 6. 29 ±1. 27) ng/mL],the differences were statistically significant( P < 0. 05). The levels of spexin in maternal and umbilical blood before and after the oral glucose tolerance test in the gestational diabetes group were( 2. 55 ± 0. 48),( 1. 94 ± 0. 39),( 1. 87 ± 0. 25) ng/mL,which were significantly lower than those in the control group [( 3. 92 ± 0. 99),( 3. 17 ± 0. 82),( 2. 94 ± 0. 73) ng/mL],the differences were statistically significant( P < 0. 05).ROC curve analysis shows. The AUC of maternal blood subfatin and spexin,umbilical cord blood subfatin and spexin in diagnosing gestational diabetes mellitus was 0. 924( 95% CI : 0. 875-0. 934,P < 0. 001),0. 901( 95% CI : 0. 849-0. 9515,P < 0. 001),0. 858( 95% CI : 0. 796-0. 920,P < 0. 001) and 0. 799( 95% CI : 0. 724-0. 873,P < 0. 001). The sensitivity was 86. 49%,81. 57%,78. 38% and 75. 68%,and the specificity was 72. 75%,75. 68%,84. 59% and 89. 24%. Conclusion The level of subfatin in maternal blood and umbilical cord blood increased and spexin decreased in gestational diabetes mellitus. It can be used as a molecular marker for diagnosing gestational diabetes mellitus.